Jeffery M Iceberg, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003330 Issued in MI

Practice address

3192 S Linden Rd
Suite B121
Flint, MI 48507

Phone

(810) 230-9300

Fax

(810) 230-1453

NPI assigned

Jan 25, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• SVS Vision Inc

  • Optometrist
  • Mount Clemens, MI
  • NPI 1194879023
  Medicare reassignment NPD
• SVS Vision Inc

  • Optometrist
  • Mount Pleasant, MI
  • NPI 1558246942
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356497432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 MACOMB",
            "city": "MT CLEMENS",
            "state": "MI",
            "postal_code": "48043",
            "telephone_number": "586-468-7370",
            "fax_number": "586-464-1472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3192 S LINDEN RD",
            "address_2": "SUITE B121",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "48507",
            "telephone_number": "810-230-9300",
            "fax_number": "810-230-1453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ICEBERG",
        "first_name": "JEFFERY",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glenda Hyatt-Tribelhorn, RN
• Michael Kevin Hyland II
• Melissa Christine Iacobelli-Champion, RN
• Mahmoud Ibrahim, MD
• Monique R Ice, MD
• Douglas Matthew Iddings, DO
• Mohsin Mohammed Idrees
• Igen on Call PLLC
• Bashir Imam, MD
• Iman Toxicology LLC

• Optometrist in Flint, MI
• Providers in Flint, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.